elt2

							                                        New York State Department of Motor Vehicles
                                         Division of Document Production Room 333
                                                     6 Empire State Plaza
                                                      Albany, NY 12228

                       APPLICATION FOR ELECTRONIC LIEN TRANSFER PROGRAM


Lending Institution:
Full Name


Street Address                                      City                         State                    Zip


Mailing Address                                     City                         State                    Zip




Administrative Contact:
Name/Title



Telephone Number (Area Code)                        Fax Number (Area Code)               E-Mail Address

(            )                                      (         )


Technical Contact:
Name/Title



Telephone Number (Area Code)                        Fax Number (Area Code)               E-Mail Address

(            )                                      (         )




     ¢           Approximate annual NY lien filing volume: _______________________

     ¢           Please provide name, address, phone number, fax number and e-mail address of ELT vendor you
                 will be using: ____________________________________________________________________
                   ______________________________________________________________________________
                   ______________________________________________________________________________

     ¢           List all lienholder codes currently assigned to your company by NYS DMV:

                   ______________________________________________________________________________

                   ______________________________________________________________________________

                   ______________________________________________________________________________

     ¢           Select one of the codes you’ve listed above to be your primary code for ELT.

                 Selected Primary Code: _________________________


ELT-2 (12/09)                                           www.nysdmv.com